Permit „ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00078
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
TIGARD. Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 1 -3, PLL
Project Description: Relocate (2) lays for restroom remodel.
Contractor: PMSI LLC Owner: COSTCO WHOLESALE CORPORATION
21195 NW EVERGREEN PKWY #204 PROPERTY TAX DEPT 111
HILLSBORO, OR 97124 999 LAKE DR
ISSAQUAH, WA 98027
•
PHONE: 503 -466 -2222 PHONE:
FAX: 503- 466 -2211
FEES
Quantity Description Date Amount
2 ea Lavatories 04/06/2012 $50.04
Specifics: 1 12% State Surcharge - 04/06/2012 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 04/06/2012 $22.46
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ilE32;/-ezv--fe___ P ermittee Signature: _ e/t/ Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Apr. 4. 2012 3:36PM No. 6237 P. 2/3
Piumbin2 rernut Agpiication
Building Fixtures • G� FOR OFFICE USE ONLY
• City of Tigard tz� Da l 6 ice, ; P erm i t N o��01O %s? - 40'00 7F
a 13125 SW Hall Blvd., Tigard, OR 9 7�2224Y"'" Pla Re �/`�
N.• �� Plea Review
Phone: 503.7182439 Fax: 503.598.1960 4 1 Date/By: Other Permit No.:
inspection Line: 503.639.4175 0 T I G A R D p ��Q� /B :
Internet: www.tigerd- or.gov �U1' Date 1 ethod: '_ Sr. Page 2 for Supplemental lnrorniarian
� �- ��'Csi�;ased��� �• • � `? ��- '.43;5 _. ? ;- _:.- -_ . ._ - _ � 1 �1�' - `'�
t '�. • 7_._ • - -� ,.. i»:. nC �.:n,c' . e .�.. -,• .rr� -.- �... :v.c� m�.r; a:. •r A. i> >:.
❑ New construction - • ❑ at For special 17 formnNon use checklist
Description Qty. I Fa. I Total
® Addition/alteration/replacement ❑ Other: New 1.2- family dwellings (includes 100 ft. for each utility connection)
E ., 74 _-_-_,. :47. ,,,,,...., , , a. Ems - r SFR 1
.. Ci1iYi1B ii .a � e ��t�1�11'1CIF�>�?A3t��.__ t .�-_ =- =_ ( ) bath 312.70
.... r : .. r-iorr. .o--. ._.,. -�- - --
❑ 1- and 2- family dwelling ® Commercial/industrial SFR bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/ kitchen 25.02
❑ Mn_srer builder ❑ Other:
y _� _ F• -^�. r. Fire sprinkler ( sq. ft.) Page 2
t lr*:= = Xb > s�Is .o i _ 6 il1 M • Site utilities:
Job site address: 7850 SW Dartmouth Rd Catch basin or area drain 18.76
City / State/ZIP: Tigard, OR 97223 DryHtill, leach lino, or trench drain 18.76
Fooling drain (no. linear ft.: __,) Page 2
Suite/bldg. /apt. no.: 1 Project name: Costco Restroom remodel Manumetured home utilities 50.03
Cross street/directions to job site: • Manholes 18,76
Rain drain connector 18.76
Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear R.: Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backftow preventer 31.27
_:_'... W . ._._..__ ��. - Backwater valve 12.51
Clothes washer 25.02
Relocate (2) lavatories in restrooms Dishwasher 25.02
• Drinking fountain 25.02
. Ejectors /sump 25.02
- - = e= .z: =; ski `�!ry/.rr•: ?J n i-_ ,,,,, r ......,,,,,,,,,,.. 7:: _
_ nion tank 12.51
y., -- 1�•�CI = - ' is • � ... - ..__. �_= Exp a
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub, 25.02
Address: Garbage disposal 25.02
City/ State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
z. Ewa /L: Cr A f: r - . -• t • e 41 :e 'Cf Interceptor /grease trap 25.02
Business name: Medical gas (value: S _ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51 •
Address: Sink/basin/lavatory 2 25.02 50.04
City /State/ZIP: Solar units (potable water) . 62.54 -
Phone: ( ) Fax: : ( ) Tub /shower /shower pan • 12.51
E -mail: Uriinal 25.02
=""" r . -: e , ; . /v., y _. .: -.: -_. : _ -_ .,:..� Water closet 25.02
-- te• - - t?Pf11i'_ - z'- ::: -:'..
a s - - -_ _. _: ' - '"---'="---"'" �:. -.-�_ , _,:; Water heater 37.52
Business name: VMS! LLC Water piping/DWV 56.29
Address: 21195 NW Evergreen Pkwy Suite 204 Otbcr: 25.02
City / State/ZIP: Millsboro, OR 97124 . Subtotal
Phone: (503) 466 -2222, Pax: (503) 466 -2211 Minimum permit fee: 572.50 1 .. S 0
• ,j/ Plan review (25% of pemtil fee)
1 j CC6Lie.:IS8286 / y Plumbing Lie no.: Slate surcharge (12% of permit fee) /
am Authorized signature; a / OW TOTAL PERMIT FEE I , . r �/
I Print name: Lanett ' obinson 1 Date: 4/4/12 Thls permit application expires if a permit Is not obtained witbin 1511 days
atter H has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
1! BuMnglPetmirs1PLMN.Penoiulpp.doe 10/01/09 440- I616T(1010a/COMWVPn)
Apr, 4. 2012 3:37PM No. 6237 P. 3/3
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
.• za.� vs ar»i°�:,. ". _Q °` F (e8)` � _ C - O -_ "X -_ - Yom_ :}r• T L-TTz •
r- - - �.��. ura[Ire= �n.o�a� e,- _ rm � e �� --
�Q �_y ..- d �
.R7;7r1•. li� trk.,, RL L'r.:LS- ::::•a.:..f•.c ?:- _.:.::._::._____c a:_- ._ -' _• - -..__ ..Ff._ .. .. C.- S•J��� S.S��i \E�OTi,
Footing drain- 1° 100' 50.03 Oto2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
Sewer - 1st 100' 62.54 3,601 to 7,200 $233.20
7,201 and Beater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' • 37.52 :,..__:.....
Storm & Rain Drain - 1st 100' 62.54 � - - - -r-
51.00 to 55,000.00 Minimum fee $72.50
Stonn & Rain Drain - each additional 100' 37.52 55,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
• r te , tgbC ° each additional $100.00 or fraction thereof, to
+t`' %• and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 foi the first $10;000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge -1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) • each additional $100.00 or fraction thereof: to
Reinspection Fees 90.00/hr and inctudiny, $50,000.00. •
Additional plan rcvicw for revisions 90.00/hr 550.001.00 and up $742.00 for the first $50.000.00 and $ 1.20 for
(minimum charge - 1/2 hour) • each additional $100.00 or fraction thereof.
Subtotal:
•
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
..., ' -- -_ , •.R.. .... ._ .._ -. .......... _� . � :t....__ • =a:;_: •seen'•...... -- - 's�? ;�:.`.Y..•�:•_o :fie
. _;s, _7 iYGi' li`IC ma it ___€
r,.,•;'� Plan review is required for any of the following.
%tWir�Y•Pi!ttti ?ri1 ° °Ea - -. -., .... - .- ...... .�.,... D;a... 5., r ,�r►dd� =� � : ; �eloc>;irr : Please check all that apply.
apP y
El Bath Tub /Shower Any new commercial building with water service 2" and
- Jecuui/Whirlpool greater, except systems designed and stamped by licensed
Car Wash - Each Stall engineer.
- Drive Thru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918- 780 -0040.
• Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities.
- Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain • ❑ Any complex structure as defined in OAR918- 780 -0040.
Eye Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
- 3 »
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings - Domestio-non -food ! s
q g
Disposal - Domestic-food related that meet the qualifications above.
- Commercial -food related
-Industrial-food related _ _
Icc MachfRefrig. Drains
Oil Separator (Gas Station) . Comments regarding fixture work:
Ree. Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non -food related 2 . -
-Bradley
- Commercial -food related
- Service
Swimming Pool Filter
Washer - Clothes • *Note: If the fixture work under this permit results in an
Water Extractor increase of sewer EDUs, a sewer permit will be Issued and
Water Closet .Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures;
\\Dataserverl\apps\lob Files\PMSI Jobs \10842- Costco Tigard\PL.MP- Pen2itApp (1).docx